While doctors are better than ever at diagnosing concussions in children, new Canadian research shows the vast majority have a lot to learn about treating symptoms.

More than half of Ontario health care professionals surveyed ignored critical recommendations for rest, sending kids back to school and sport too quickly.

Responding to this startling evidence of “suboptimal” care, an Ottawa physician led experts across North America in creating the first comprehensive guidelines for identifying and managing pediatric concussions. The online document, which includes sections geared to parents, teachers and coaches as well as those on the health care system’s front lines, was released online Wednesday.

“We want to ensure people are practising the latest best evidence,” said Dr. Roger Zemek, director of pediatric emergency research at Children’s Hospital Eastern Ontario and the project leader on the guidelines. “This is so important because children get more concussions than adults do, with increased risk because their brains are still developing.”

Zemek’s group, which included 30 researchers and clinicians across North America, dissected more than 4,000 academic papers to create the guidelines. The work was funded by the Ontario Neurotrauma Foundation.

“It’s a good compendium of where we are right now,” said Dr. Stephen Porter, head of emergency medicine at The Hospital for Sick Children in Toronto. He was not involved in the document’s development, though the hospital is participating in a multi-year study lead by Zemek on identifying patients who are high risk for developing symptoms that last longer than one month.

“A family could in good faith go to two different doctors and get two different things that they’re told to do and be frustrated and confused,” he said. “There is a mixed picture of evidence that is out there about what helps and what doesn’t.”

Zemek’s study on “predicting and preventing post-concussion problems in pediatrics” will track 2,000 children with concussions at nine major hospitals Canada-wide. It’s expected to fill important gaps in research and will likely result in a modified set of guidelines next year.

About 30 per cent of children who suffer a concussion will take a month or more to recover — a rate roughly double that for adults.

The first phase of the study is expected to be published next spring, Zemek said.

“It’s the first important step in a series of research projects that will allow us to better understand both who is at risk of persistent symptoms and what we can do about it,” Porter said.

Zemek and his colleagues saw a red flag when they surveyed 753 health care providers in Ontario and found that only a quarter of doctors reported using concussion tools to assess and track symptom recovery and that only 37 per cent were correctly applying best evidence recommendations for physical rest.

Zemek compares the brain to a battery.

“It stores our memories, it stores how we think, how we feel,” he said. “When you have a concussion, the circuits of that battery are not working and that needs time to heal itself and recover. If you go from normal, full load of that battery down to half, if patients continue to try to do homework or go to school, even just run around, they’re using up that battery storage and that may not allow the brain the time and energy it needs to heal itself.”

Even something as simple as limiting screen time can help that process.

“Screen time actually requires a tremendous amount of brain time,” Zemek said. “The focusing your eyes need to do on a screen is much more straining than just reading a book. The strain of that bright light can exacerbate symptoms.”

Worst-case scenario, by not providing the brain with the rest it needs to repair itself, “the duration of recovery is probably going to be significantly longer and you’re also putting that child at a high risk of sustaining rare but tragic second-impact syndrome, where the brain basically shuts down,” Zemek said. “It can result in death.”

Nick Reed, an occupational therapist at Holland Bloorview Kids Rehabilitation Hospital who helped create the guidelines, hopes a standardized approach to concussion care will at least get doctors and parents asking the right questions, leading to earlier interventions.

“It’s something that we can really as a collective buy into,” he said. “And make sure that everyone is treating this injury with the same level of respect to get these kids healthy.”

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